Dermatitis, Diaper
Basics
Description
- Diaper dermatitis is a rash occurring under the covered area of a diaper (named for typical location, not etiology). It is usually initially a contact irritant dermatitis but can be caused by or contributed by systemic conditions.
- Rarely, a serious condition, but patient discomfort and caregiver anxiety are considerations.
- System(s) affected: skin/exocrine
- Synonym(s): diaper rash; nappy rash; napkin dermatitis
Geriatric Considerations
Incontinence is a significant cofactor in the elderly population.
Epidemiology
Incidence
- The most common dermatitis is found in infancy.
- Peak incidence: 7 to 12 months of age and then decreases
- Lower incidence is reported in breastfed babies due to lower pH, urease, protease, and lipase activity.
Prevalence
Prevalence has been variably reported from 4–35% in the first 2 years of life. Upward of 75% of infants will have episodes of varying duration and severity in United States. Severity varies: 58% slight symptoms; 34% moderate; 8% severe. Underreporting contributes to difficulty in determining impact of condition.
Etiology and Pathophysiology
- Immature infant skin with histologic, biochemical, functional differences compared to mature skin
- Wet skin is central in the development of diaper dermatitis, as prolonged contact with urine or feces results in susceptibility to chemical, enzymatic, and physical injury; wet skin is also penetrated more easily.
- Fecal proteases and lipases are irritants.
- Superhydrase urease enzyme found in the stratum corneum liberates ammonia from cutaneous bacteria.
- Fecal lipase and protease activity are increased by acceleration of GI transit; thus, a higher incidence of irritant diaper dermatitis is observed in babies who have had diarrhea in the previous 48 hours.
- Once the skin is compromised, secondary infection by Candida albicans is common. 40–75% of diaper rashes that last >3 days are colonized with C. albicans.
- Bacteria may play a role in diaper dermatitis through reduction of fecal pH and resulting activation of enzymes.
- Allergy is exceedingly rare as a cause in infants.
Risk Factors
- Infrequent diaper changes
- Improper laundering (cloth diapers)
- Family history of dermatitis
- Hot, humid weather
- Recent treatment with oral antibiotics
- Diarrhea (>3 stools per day increases the risk.)
- Dye allergy
- Eczema may increase the risk.
General Prevention
Most effectively managed by prevention including rigorous attention to hygiene
Commonly Associated Conditions
- Contact (allergic or irritant) dermatitis
- Seborrheic dermatitis
- Psoriasis
- Candidiasis
- Atopic dermatitis
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Citation
Domino, Frank J., et al., editors. "Dermatitis, Diaper." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116174/all/Dermatitis_Diaper.
Dermatitis, Diaper. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116174/all/Dermatitis_Diaper. Accessed November 4, 2024.
Dermatitis, Diaper. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116174/all/Dermatitis_Diaper
Dermatitis, Diaper [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116174/all/Dermatitis_Diaper.
* Article titles in AMA citation format should be in sentence-case
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